Anticoagulation discharge treatment recommendations in patients admitted with a first-time diagnosis of atrial fibrillation

Background Direct oral anticoagulants (DOACs) have emerged as an alternative to warfarin for stroke prevention in atrial fibrillation (AF) patients. This study aimed to evaluate anticoagulation recommendations at discharge for newly diagnosed AF patients and investigate associated clinical factors. Methods We retrospectively analysed the electronic medical records of adult patients hospitalized with new-onset AF at a large tertiary medical centre between January 2014 and April 2025. We examined patient demographics, clinical characteristics, laboratory indices, and anticoagulation recommendations at discharge. Logistic regression models were used to identify factors associated with DOAC prescription and trends over time. Results The study consisted of 3857 adult patients. DOAC prescription rates significantly increased over time, reaching 100% by 2023 and 2024. Patients with chronic kidney disease (CKD) were less likely to receive DOACs. Apixaban was the most frequently prescribed DOAC, particularly in older patients. Conclusions This study demonstrates a significant shift towards DOACs as the preferred anticoagulation therapy for newly diagnosed AF patients, aligning with current guidelines. However, CKD remains a factor influencing DOAC prescription. Key messages What is already known on this topic: Atrial fibrillation (AF) increases stroke risk, traditionally managed with warfarin but now increasingly treated with direct oral anticoagulants (DOACs). However, research is limited on anticoagulation recommendations at discharge in newly diagnosed AF patients, highlighting the need to understand clinical factors influencing these decisions. What this study adds: This study reveals a complete shift to DOAC prescription for newly diagnosed AF patients, with apixaban preferred in older patients. Although studies in recent years suggest that DOACs can be safe and effective in patients with chronic kidney disease (CKD), we find that DOACs prescriptions were less prevalent in these patients in comparison with warfarin. How this study might affect research, practice or policy: These findings suggest an opportunity to enhance clinician awareness and guidelines around DOAC use in elderly or CKD patients, potentially guiding future research and policy to improve AF management in these subgroups.